1 reviews | Active since Nov 2022
Authorization declined
I've been with Medshield for a couple of years now, and I have not experienced any problems with it, until recently. I submitted a request for authorization to have a procedure done. Two of my doctors provided motivation letters indicating that the procedure is a medical necessity. Medshield even requested additional, SENSITIVE information, which I did provide. Two consultants I had spoken to on two different occasions did notify me that the medical advisor did confirm that I meet the criteria to have the procedure done. However, Medshield came back with a decline, stating that it is a scheme rule exclusion. Why was the SENSITIVE, additional information requested by Medshield in the first place if indeed it is a scheme exclusion? What of the medical information provided by my doctors? Why was my application reviewed by the medical advisor if this is an exclusion, on top of that the medical advisors findings are not even taken into account! I had also been notified by the consultants that my procedure can be covered by Medshield if I provide information indicating that this is a medical necessity. The pain I endure on a daily basis is horrific, meanwhile I have medical aid......
Medshield Medical Scheme has acknowledged your complaint and is currently investigating.
Kindly note that your concerns have been prioritised and feedback will be provided within 5 working days.
Yours sincerely,
Medshield
Medshield Medical Scheme has acknowledged your complaint and is currently investigating.
Kindly note that your concerns have been prioritised and feedback will be provided within 5 working days.
Yours sincerely,
Medshield
Medshield Medical Scheme has acknowledged your complaint and would like to thank you for bringing your concerns to our attention.
Kindly be advised that your complaint has been reviewed and a response has been forwarded to your email.
Yours sincerely
Medshield Medical Scheme
Medshield Medical Scheme has acknowledged your complaint and would like to thank you for bringing your concerns to our attention.
Kindly be advised that your complaint has been reviewed and a response has been forwarded to your email.
Yours sincerely
Medshield Medical Scheme
Thank you for responding timeously. I am however concerned about the contradicting information I receive. If you listened to the recordings of the last 2 calls I made, the 2 consultants advised me that according to the notes made by the medical advisor, I meet the requirements to have the procedure done. However, the email response you are referring to above indicates that the medical advisor declined. Why would 2 different consultants give me exactly the same information, and now I receive information that contradicts them both? This is quite concerning. Your feedback on this would be much appreciated.
Thank you for responding timeously. I am however concerned about the contradicting information I receive. If you listened to the recordings of the last 2 calls I made, the 2 consultants advised me that according to the notes made by the medical advisor, I meet the requirements to have the procedure done. However, the email response you are referring to above indicates that the medical advisor declined. Why would 2 different consultants give me exactly the same information, and now I receive information that contradicts them both? This is quite concerning. Your feedback on this would be much appreciated.
